Two Kinds Of Radix Salviae Miltiorrhizae Injection For Angina Pectoris: A Systematic Review And Pharmacoeconomics Analysis

Angina pectoris is a common and frequently occurring disease,becoming the major cause of death. In recent years, the incidence ofangina pectoris is increasing and occurring younger. The burden ofsociety and patient’s family is heavy. Our study was aimed tosystematically review the effectiveness and safety of Salvianolateinjection and Sodium tanshinone ⅡAsulfonate injection for patients withangina pectoris, and evaluate the cost of these two medicines. While theindirect comparison method was used to compare the efficacy and safetyof these two kinds of drug, cost-effectiveness analysis was also used forthe pharmacoeconomic aspects. We expect that the evidence of our studywill be better used in the patients and clinicians.Literature searches were conducted at major bibliographicaldatabases including PubMed, EMbase, Cochrane Library, China NationalKnowledge Infrastructure (CNKI), Wan Fang Data, Chinese ScientificJournal Database (VIP)between the inception dates of databases and2013(last search on30May2013). Inputs for the meta-analysis were chosenfrom the random control trials (RCTs) published both in the domestic andoverseas about Salvianolate injection and Sodium tanshinone ⅡAsulfonate injection in patients with angina pectoris. Ninety-three trialsinvolving8,086patients were included as a result, in which65trialscontaining5,919patients exist in the literatures compared Sodiumtanshinone ⅡAsulfonate injection with routine therapy,28trialscontaining2,167patients involving Salvianolate injection. Themethodological quality of the included studies was generally lower. Obvious superiority was seen in the comparison with routine therapy ofthese two kinds of medicines in meta-analysis (RRSTI=1.24,95%CI:[1.21,1.27], P<0.00001; RRSI=1.31,95%CI:[1.26,1.37], P<0.00001).Incidences of adverse drug reaction were0.02%(51/2509) and0.016%(12/752) respectively. In the indirect comparisons, Salvianolateinjection was superior to Sodium tanshinone ⅡAsulfonate injection inthe symptom improving on angina pectoris patients(RRIC=1.06,95%CI:[1.01,1.11], P=0.02), non-significance was found in the safety(RDIC=0.0058,95%CI [-0.0007,0.0123]，P=0.08). Cost-effective ratio ofSodium tanshinone ⅡAsulfonate injection in treating angina pectoris is2311.18,and Salvianolate injection in the corresponding was2671.10. Aslight instability was seen in the sensitivity analysis.Based on the existing researches, we have found that in treatingangina pectoris Salvianolate injection was superior to Sodium tanshinoneⅡAsulfonate injection in the symptom improving. The incidences ofadverse drug reaction of the involving drug were low. Non-significancewas found in the safety. Cost-effective advantage was seen in the Sodiumtanshinone ⅡAsulfonate injection group, but it was not stable enoughwhile the cost changing. However, concerning methodological quality ofincluded studies, it is difficult to draw a definitive conclusion, furtherlarge-scale high-quality trials are needed.